Waters- Form 1- 6-18-15 FORM 1 S ATEIV1I ENT OF 2014
Please print or type your name,mailing FI{ Ali CIA.i INTERESTS FOR OFFICE USE ONLY:
address,agency name,and position below:
LAST NAME--FIRST NAME--MIDDLE NAME:
WM-ers Mai- rv' 13�y ►-1�e
MAILING ADDRESS:
1(62q S-CM trig (z-oeld Received
CITY: ZIP: COUNTY:
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NAME OF AGENCY:
C 1 UL ' ar,<A-I'L i?xa 1.
NAME w F OFFICE OR POSITION HELD OR SOUGHT: Office of City Clerk
At Q - , On owwvs►ss fa,' Seed-
You are not limited to the space on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF 14 CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
**** BOTH PARTS OF THIS SECTION MUST BE COMPLETED ****
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR,WHETHER BASED ON A CALENDAR
YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING
EITHER(must check one):
DECEMBER 31, 2014 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES FEWER
CALCULATIONS, OR USING COMPARATIVE THRESHOLDS,WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions
for further details). CHECK THE ONE YOU ARE USING:
❑ COMPARATIVE(PERCENTAGE)THRESHOLDS OR III DOLLAR VALUE THRESHOLDS
PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
C OM< Vc4 S d_I lk A- - • kv,,n`
340$2
PART B-- SECONDARY SOURCES OF INCOME
[Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
51 r-C .(, Aht Y'f'61 Go tot t)( -CV a(ak 610 1/ R Sdal
PART C--REAL PROPERTY [Land,buildings owned by the reporting person-See instructions]
(If you have nothing to report,write"none"or"n/a") FILING INSTRUCTIONS for when
and where to file this form are
located at the bottom of page 2.
•
g �►h L.-L Z INSTRUCTIONS on who must file
this form and how to fill it out
begin on page 3.
CE FORM 1-Effective:January 1,2015 (Continued on reverse side) PAGE 1
Adopted by reference in Rule 34-8.202(1),F.A.C.
PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions]
(If you have nothing to report,write"none"or"n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
l aS k G.`` 1l1t✓4 V\l mil.
PART E—LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF CREDITOR ADDRESS OF CREDITOR
W?3 L V 1 ?t - 10 t12,9x FAAA ?)(
� v L z ,
�✓■ tA(�� k ()Lc, °7Q ( Z K 1a I I�cr>1 - 11 105
PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions]
(If you have nothing to report,write"none"or"n/a")
BUSINESS ENTITY#1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY /
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY •
I OWN MORE THAN A5%INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
If a certified public accountant licensed under Chapter 473, or
Signature: attorney in good standing with the Florida Bar prepared this
form for you, he or she must complete the following statement:
I prepared
(/1A- ' the CE Form 1 in accordance with Section 112.3145, Florida
Statutes, and the instructions to the form. Upon my reasonable
knowledge and belief,the disclosure herein is true and correct.
Date Signed:
CPA/Attorney Signature:
L t Date Signed:
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form,including If you were mailed the form by the Commission Initially,each local officer/employee,state officer,
signing and dating it,send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within
sheet(pages 1 and 2)for filing. your annual disclosure filing, return the form to 30 days of the date of his or her appointment
that location. or of the beginning of employment. Appointees
If you have nothing to report in a particular Local officers/employees file with the who must be confirmed by the Senate must file
section, you must write "none" or "n/a" in that Supervisor of Elections of the county in which they prior to confirmation, even if that is less than
section(s). permanently reside. (If you do not permanently 30 days from the date of their appointment.
reside in Florida, file with the Supervisor of the Candidates for publicly-elected local office must
NOTE: county where your agency has its headquarters.) file at the same time they file their qualifying
MULTIPLE FILING UNNECESSARY: papers.
State officers or specified state employees Thereafter, local officers/employees, state
A candidate who previously filed Form 1 because file with the Commission on Ethics, P.O. Drawer
of another public position must at least file a copy 15709, Tallahassee, FL 32317-5709; physical officers, and specified state employees are
of his or her original Form 1 when qualifying.A address:325 John Knox Road,Building E,Suite required to file by July 1st following each calendar
candidate who files a Form 1 with a qualifying 200,Tallahassee,FL 32303. year in which they hold their positions.
officer is not required to file with the Commission Finally,at the end of office or employment,each
or Supervisor of Elections. Candidates file this form together with their local officer/employee,state officer,and specified
qualifying papers. state employee is required to file a final disclosure
To determine what category your position falls form(Form 1 F)within 60 days of leaving office or
under, see the "Who Must File" Instructions on employment.However,filing a CE Form IF(Final
page 3. Statement of Financial Interests)does not relieve
the filer of filing a CE Form 1 if he or she was in
Facsimiles will not be accepted. their position on December 31,2014.
CE FORM 1-Effective:January 1,2015. PAGE 2
Adopted by reference in Rule 34-8.202(1),F.A.C.